Parents, Relationships and Residential Treatment

by John Stein

John is a member of the goodenoughcaring Journal’s editorial group. He is the author of Residential Treatment of Adolescents and Children: Issues, Principals and Techniques. His essays, articles and papers have been published widely. He is a regular and generous contributor of articles to the goodenoughcaring Journal

Parents,Relationships and Residential Treatment

I have worked with children who came to residential treatment by two different paths here in Louisiana. The first path involved children who were placed by juvenile courts because of their behaviour, either unruly and ungovernable, or criminal. These oppositional and sometimes Conduct Disordered children most certainly presented challenges. The second path involved children who were removed from their homes by family courts for their protection due to neglect or abuse. Ironically, these children presented by far the more difficult challenges than the children with behavioural problems. In both cases, relationships with parents and family were important.

Children from Juvenile Court

Here in Louisiana, as I suspect in many other places, children come to the attention of juvenile courts because of their behaviour. It may be status offenses such as truancy, underage drinking, running away, sexual acting out, and other behaviours that would not be criminal for adults. Or it may be criminal offenses such as shoplifting, theft, burglary, assault, weapons offenses, illegal use of drugs, etc. Children who commit status offenses may be adjudicated as a ‘Child in Need of Supervision’ and placed on probation. If the court determines that such children require additional supervision, they may be placed in the custody of the Office of Juvenile Services for residential placement. Children who commit criminal offenses are adjudicated as ‘Delinquent.” They may be placed on probation as well, or sentenced directly to the Office of Juvenile Services for residential placement or incarceration.

Although there may be some problems with the parents, foster care with another family is not an option, since courts have decided that it is the behaviour of the children that necessitates placement. Residential placement is, therefore the least restrictive alternative for both children adjudicated as in need of supervision or as delinquent. Children can return home when their behaviour has improved, or when they have completed their sentence.

When these children come for admission to residential placement, they are often brought or accompanied by their parents. It is important to involve parents as fully as possible in their children’s treatment throughout treatment. Children may have weekend and holiday home passes to maintain their relationships with family, peers, and their community. More, when the placement is in or near children’s community, they may even continue to attend their own schools to maintain relationships.

Although relationships between children and parents may be somewhat strained, they are usually relatively intact. Residential placement gives both children and parents a break from each other. When children return home for weekend passes, they are likely to return as welcome guests during a more relaxed time. There may be fewer chores. There is not the competition for the bathroom that there is on weekdays to get everyone off on time for work and school.

Feelings

Let’s take a moment to think about feelings. Children are, of course, apprehensive, perhaps even fearful. It is likely the first time they have been separated from their family, peers, and community. But they know it is because of their behaviour. They are responsible. And then there is the apprehension, perhaps even fear, of being the new person in a new group. Will I be accepted? Will I be teased? Will I be bullied?

Now, let’s think about the feelings of parents. They are saying goodbye to their children, perhaps for the first time. Will my child be safe with these ‘thugs’? More, there have got to be some feelings of inadequacy, as in, “I have failed as a parent.”

James Rogers was one of the most competent professionals with whom I’ve had the good fortune to work. When parents accompanied their children to the admissions process, after their child was taken by staff to get settled, James would always take some time to talk with the parents. First, he would take some time to talk a little more about our program and to assure them that their child would be SAFE here. Then, he would tell them that he knew the struggle they had been through with all the difficulties their child had presented, that he knew they had done their best, and that it had perhaps been too much for any parent. Then, he would tell them that they deserved a break and to take some time for themselves, to relax, perhaps to go out to dinner. Just them. For themselves. That they could relax for the first time in years, because their child was safe, and take some time for themselves because they deserved it. I really can’t capture his words. It was different for each family. But the message was always the same. You did the best you could. Your child is safe. You can relax. You deserve it.

Testing

Needless to say, these oppositional children would on occasion challenge authority. James Rogers would speak of this as testing behaviour–children testing the limits, as if to see what they could get away with. I personally think testing behaviour is a relatively normal behaviour of most mammals. Exploring the limits of their environment is what animals do. Put a cat in a new house and watch. Very soon, the cat will go from room to room, all around the perimeter. Exploring. Animals, including people (and as my father-in-law was fond of saying–children are people, too), need to know the limits, the boundaries, of their environments. Eventually, they learn the limits and the testing behaviour diminishes.

Children from Family Court

Here in Louisiana, and I suspect in many other jurisdictions as well, children come to the attention of family court through child protective services. Protective services investigate reports of neglect or abuse in the home. If neglect or abuse is substantiated by a family court, courts may order families into services with the Office of Community Services, which now has quite a continuum of services, beginning with in-home services for the family. When the situation in the home is seriously bad, the family court may place children in the custody of the Office of Community Services for placement for their protection and safety.

In such cases, the problem or fault is with the parents. Children are presumed to be victims. The assumption is that all that these children need is a caring family. The message is quite clear to both parents and children: The parents are not ‘good enough;’ the child needs a better home.

The preferred option is placement with another family member. It is considered the least restrictive alternative. It is also the most economical. When that is not an option, or has been tried and does not work, placement with a foster family is the next least restrictive (and least expensive) alternative. Residential placement, the most restrictive and most expensive alternative, is to be avoided until all other options have been exhausted. Besides, ‘everyone’ knows that residential ‘care’ is not a good place for children.

When a ‘good enough’ family is found, all may be well.

But all is not always well. Some first-time foster families may not be ready for children. Perhaps foster parents, having thought they were unable to have children, are surprised to find themselves expecting a child of their own. Perhaps the primary breadwinner gets transferred out of the state. Perhaps they expected gratitude for rescuing such children and instead find children who do not feel gratitude and are less than cooperative. Their lives have been disrupted through no fault of their own. Not only are they removed from their families, but from their peers, their schools, and their neighborhoods. Sometimes, such children have been damaged by experiences in their own homes so that they present some challenges in a new home. They may tend to feel the need to test the limits of their new environment (see above). Sometimes, children who have been removed from their families for abuse find more abuse in a foster home. For whatever reason, foster children sometimes have to be removed again. The search for a ‘good enough’ family may go on for several years, through several or many families. More damaged relationships–foster family, peers, school, community.

But foster care is still the least restrictive alternative. And so it is tried. Again. And again. And again. After all, it was the families that were the problem. There is nothing wrong with the children. All they need is the care of a caring family.

Feelings

During the process, children tend to become more challenging. Relationships with foster families, peers, schools, communities, are terminated again and again. Such children cannot trust relationships with anyone, cannot invest in relationships. Their education suffers. How can they commit to their education when they do not know where they will be going to school next year? Or next month? Or next week? And even when parental relationships have been totally sundered, they continue to remain important for many children. Sometimes they become idealized in fantasy. It is difficult for other relationships to measure up to the fantasized ideal. How often have I heard, “You’re not my mother. You can’t tell me what to do”?

Testing

Instead of a bit of testing of the limits of their environment (see above), some children begin to feel a need to test relationships–they have learned that relationships are not to be trusted. (Will you be there for me when I have a problem? Ok. You handled that problem. Can you handle me for another?) It’s not conscious. They simply feel insecure. In order to feel safe and secure, they have to have some sense of where that line is that they dare not cross or they will be moved once again. The closer to the line they get, the more insecure they feel. In order to feel secure, they have to sense exactly where that line is. (Again–this is not conscious thought–it is feelings). And the only way they can feel secure about exactly where that line is, is to step over it, to cross it. Now they know where the line is. Because they have been removed once again

Or, if for some reason they find a placement unpleasant or uncomfortable, they know exactly how to get moved to the another. Some children learn to thrive on change.

Through this process of multiple placements, children get older. It is more difficult to find foster families for older children.

And so residential placement becomes the only remaining alternative. And the testing behaviour, the unrelenting search for the line, continues. It is not unusual for some of these children to get thrown out by residential programs, as well. (Especially one they do not like for some reason, or any, reason.)

Finally, Residential Placement

When children from family court, removed from their own homes for their protection and safety, finally arrive in residential treatment, well…

First of all, family relationships are severely damaged, perhaps even totally sundered. Second, children’s ability to form other relationships has most often been severely impaired.

Residential programs provide the best hope for these children to begin to learn to trust again and invest in relationships. They can offer multiple staff, adults of both genders with varied interests and experiential and ethnic backgrounds for children who have relationship challenges. This allows children some choice among adults with whom to begin to form relationships.

While relationships with individual staff may not be permanent (staff come and go), the relationship with the program should be permanent. To be effective with these children, residential programs must have a the policy of not throwing children out because of problems. Residential programs should know their limits and screen referrals carefully. They should not accept children whose needs they cannot meet. For example, a lightly staffed group home should be wary of accepting large adolescents with a history of serious physical aggression. In a well-staffed community program, I was wary of accepting children with addictive disorders-we had no expertise in addiction and it posed a risk to other residents. Once they accept children for treatment, residential programs must be committed to meeting their needs, no matter what. When residents sense this, they are more likely to begin to feel safe and secure.

Finally, the needs of these children are unique. While children from the juvenile justice system can expect to return home at some point and to have family support into adulthood, children from family courts very often do not have such expectations. Many jurisdictions have few if any supports for children once they reach the age of eighteen, although this seems to be improving. For children from family courts, their futures are often uncertain. It is difficult for them to commit to or invest in uncertain futures. They must be prepared to live independently unless some supports can be identified. Sometimes, once they become adults, reuniting with family is possible. Other times, there are other relatives who may offer some support. But, even when reuniting with parents may never be possible (death, incarceration, serious substance abuse, mental illness, or abandonment), for some of these children, their parents, especially their mothers, continue to be important.

The Fighting Ritual

I have observed this ritual on several occasions in residential settings. It begins when two children get into a tiff. They begin exchanging provocative insults. Finally, running out of anything else to say, one child responds with, “Your mama!” This may be enough to provoke the other child to throw the first punch. If not, the other child responds with, “Your mama’s mama!” If that is not enough, the first child responds with, “Your mama’s mama’s mama!” It never goes beyond three ‘your mamas.’ Once, after one of these fights, I had a young boy in my office for a chat. At one point, I said very calmly, “Your mama’s a nice lady.” The boy jumped up and ran from my office and out of the building screaming, “He said my mama! He said my mama!” I never tried that approach again.

Relationships with their mothers for some of these children are not to be touched by others. It is private, and cherished.

Conclusions

We should never underestimate the importance of family relationships in residential treatment. Children referred from juvenile courts because of their behaviour should be returning home to continue their growth and development. Family relationships are likely to have been stressed or strained, perhaps due to children’s behaviour, perhaps due to parents’ response to children’s behaviour, more likely, due to both. These things can be changed. Children can be taught to behave more appropriately. (Please note that I said ‘taught,’ not coerced into behaving by strict and punitive point systems or other ‘behavioural’ approaches.) Parents can be coached to respond to their children in better ways. Home passes can be used judiciously to allow for practice, new experiences, and improved expectations and relationships. Both families and children can work together for reunification and look forward to it.

Children from family courts…Well, every situation is different. There are more differences than similarities. Some parents are deceased. Some are incarcerated. Some are mentally ill. Some are just incapable of raising their children for other reasons, perhaps substance abuse, severe poverty, or just a life style that involves multiple sexual relationships or criminal activity. Some may have just abandoned their children and disappeared. Some, for what ever reasons, tend towards severe emotional, physical, or sexual abuse. And some may, with support, regain custody, or at least be there as some support when their children reach adulthood.

Some resilient children seem to have ‘moved on’ from their childhood home. Others have been harmed by their experiences, some most seriously. I think of children who have been repeatedly abused sexually. These children were not treated as people but rather as objects to be used for someone’s gratification. I confess to being woefully ignorant about sexual abuse for too much of my career. Sex was always pleasurable for me, and so I thought, ‘Ok. You had sex at an early age–when the rest of us were just thinking about it. Get over it and get on with your life.’ But that is not how it was for them. Sex was not pleasant for them. It was a duty. They were not willing partners. They were objects. What does that do for one’s identity and self esteem? For one’s ability to have trusting mutual relationships with others?

As we work with these children in their day-to-day in-the-moment lives, parents may not seem so important at the time, but for many children, they are always there, in the background, in their history. Parents are important in our culture. This is why some children, given up for adoption at birth and raised successfully and happily in their adoptive homes, at some point may invest considerable time and effort in finding their birth mothers or their biological fathers. They seek the relationships. Perhaps understanding why. Perhaps to let them know they are ok. Perhaps to forgive them. Perhaps even they don’t know. Just to fill a void?

Some children may require the competence of trained and experienced therapists for these issues, beyond the scope of day-to-day, in-the-moment living, but those working with these children on a daily basis should not lose sight of the importance of family. I think it important that children be allowed at least a 5 minute call to their parents every day, whenever they wish (within reason), regardless of points, privileges or anything else. The more problems they are experiencing, the more important that phone call may be for them.